To see the usefulness of CT in evaluation of response to treatment in patients with mediastinal tuberculous lymphadenitis (MTL), we analyzed the initial CT patterns and follow-up CTs or serial plain radiographs during 18 months antituberculous
chemotheraphy in 58 consecutive patients. CT patterns of MTL at the beginning of treatment were categorized into solid type (n=8), low density with peripheral rim enhancement type (n=36), extranodal extension type (n=9) and calcified type (n=5).
According to the response to treatment, each patients was categorized into prompt response group (response within the first three months and no residual lymph node after one year), slow response group (response after three months but residual
lesion
after one year), no response group (no change in size during 18 months treatment) and temporal increase group (temporal increase in size during the treatment but ultimately improved with chemotheraphy). Among 29 cases of prompt response group, 20
cases
had large low-density areas, 6 cases had diffuse or extensive node involvement with extranodal extension or tracheal compression. Two patients with acquired immune derfciency syndrome belonged to this group. Fifteen cases of slow response group
had
low-density nedes in 7 patients and small solid or extranodal-extension nodes in 6 patients. They were associated with disseminated pulmonary tuberculosis, generalized lymphadenopathy or other organ(pericardium, brain, bone or abdomen)
involvement.
In 5
cases of no response group, there were 3 cases of calcified node and 2 cases of small solid nodes. Nine cases of temporal increase group included low density type of MTL only. And they were associated with disseminated pulmonary of endobronchial
tuberculosis. In conclusion, response to antituberculous chemotherapy could be predicted in patients with MTL on the basis of CT findings before treatment.
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